It’s Time to Rethink Water Fluoridation

By Elizabeth "Andie" Shin, DDS

Bethesda Chevy Chase Pediatric Dentistry

. https://bccpediatricdentistry.com/

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It’s Time to Rethink Water Fluoridation

A Modern Pediatric Dentist’s Perspective

Let me start with something important: I’m not against fluoride.

In fact, I’ve used it every day in my dental practice for almost 30 years—across hospitals, universities, the military, private clinics, and even on Native American reservations. I’ve seen fluoride varnish reverse early cavities, and fluoride toothpaste strengthen enamel in the children who needed it most.

But now, like many health professionals who care deeply about children’s well-being, I’m asking a serious question:

Is putting fluoride into everyone’s tap water still the best way to protect our kids’ teeth?

It might have made sense 80 years ago. But with everything we now know—about fluoride, nutrition, modern health risks, and exposure sources—it’s time to take another look.

A Strange Origin: From Industrial Waste to Public Health Policy

Fluoride didn’t enter public water systems because of dentistry.
It began as industrial pollution.

In the early 1900s, major corporations like ALCOA (Aluminum Company of America), DuPont, and fertilizer manufacturers were facing lawsuits. Their factories were releasing toxic fluoride gases that damaged crops, sickened livestock, and harmed communities nearby.¹ ²

Meanwhile, a dentist in Colorado—Dr. Frederick McKay—noted that patients had unusual brown stains on their teeth. Oddly, those teeth were less prone to cavities.³ By 1931, ALCOA chemist H.V. Churchill found the cause: natural water in some areas contained fluoride—up to 13.7 parts per million (ppm).⁴

Suddenly, fluoride wasn’t just a pollutant. It had a potential upside.

Then came the pivot. In 1939, Dr. Gerald Cox of the Mellon Institute—closely tied to ALCOA—suggested adding fluoride to drinking water to prevent tooth decay.⁵ This wasn’t driven by public demand—it served an industrial purpose.

Dr. H. Trendley Dean at the National Institutes of Health later promoted fluoridation. But his research would eventually be criticized for poor design, missing control groups, and cherry-picked data.⁶ ⁷ Investigative journalist Christopher Bryson, in The Fluoride Deception, highlighted how politics and flawed research helped launch a national policy.⁸

In 1945, Grand Rapids, Michigan, became the first U.S. city to fluoridate its water—not with medical-grade fluoride, but with an industrial byproduct of fertilizer manufacturing.⁹ ¹⁰

The public was never consulted.

What the Science Actually Supports: Topical Fluoride Works

Fluoride used on the teeth—in toothpaste or varnish—does work.
It reverses early decay, strengthens enamel, and protects against acid attacks. That’s why pediatric dentists like me use it every day.

But swallowed fluoride? That’s a different story.

Drinking fluoride doesn’t do much to prevent cavities between teeth—the most common and hardest kind to reach in children.¹¹

Does Water Fluoridation Still Make Sense?

Despite nearly 80 years of water fluoridation, here’s what we see:

• Over 1 in 5 children (ages 6–11) in the U.S. have untreated cavities.¹²
• Countries like Sweden, Germany, the Netherlands, and Japan don’t fluoridate their water—and yet have similar or better dental health outcomes.¹³
• These countries emphasize topical fluoride, education, and access to care—not mass exposure through drinking water.

Even in affluent communities, interproximal decay—cavities between teeth—is on the rise.¹⁴ Water fluoridation does little to prevent these.

Fluoride Exposure Is Coming from Everywhere

Today’s children are exposed to fluoride from multiple sources:

• Swallowed toothpaste (especially in toddlers)
• Foods and drinks made with fluoridated water
• Tea, processed juices, and infant formula
• Pesticides on produce
• Mechanically processed meats

Depending on diet and behavior:

• Infants may ingest 1.2–1.6 mg/day
• Children: 1.6–2.2 mg/day
• Adults: up to 2.9 mg/day—or more in hot weather or during exercise.¹⁵

Fluoride is quickly absorbed in the gut, but only partially excreted. In children (with immature kidneys) and in adults with kidney disease, much more fluoride is retained in the body.¹⁶ Over time, it accumulates—in the bones, brain, and pineal gland.¹⁷

And It’s Not Just Swallowing—It’s Bathing, Showering, and Washing

Fluoride exposure doesn’t only come through drinking water.

A 1984 study found that up to 64% of water-borne contaminants—including fluoride—can enter the body through the skin during activities like showering, bathing, and hand-washing.¹⁸

While European health authorities argue that dermal absorption is minimal under typical pH levels,¹⁹ other experts note that repeated exposure through warm water may increase uptake, especially in vulnerable individuals.²⁰

In short, fluoride exposure isn’t limited to what we drink. It touches every part of daily life.

So… Who Oversees The Fluoride That Goes Into Our Water?

Oversight of fluoride in tap water is fragmented—and unclear:

• The EPA sets a maximum contaminant limit (4.0 mg/L), but it doesn’t promote or regulate fluoridation programs.²¹
• The FDA regulates fluoride in toothpaste and supplements—but not in municipal water systems.²²
• The CDC offers guidelines (currently 0.7 mg/L), but has no enforcement authority—fluoridation decisions are left to local and state agencies.²³

And the fluoride used? It’s not pharmaceutical-grade.
It’s fluorosilicic acid, an industrial waste product captured from fertilizer plant smokestacks.

Federal law doesn’t require each shipment to be tested. Trace levels of arsenic, lead, and radionuclides have occasionally been detected—even if below legal thresholds.²⁴ ²⁵

No single agency is fully responsible for its quality or safety.

What About Low-Income Communities?

Supporters often say fluoridation helps poor children. But here’s the reality:

• Baltimore, MD has fluoridated water—and high rates of childhood decay.²⁶
• Los Angeles has been fluoridated since 1961—yet low-income areas still face a dental health crisis.²⁷
• Detroit and Cleveland, both fluoridated, show similar patterns.²⁸

The issue isn’t lack of fluoride.
It’s lack of education, prevention, access to care, and nutrition counseling.

The Bigger Picture: Diet, Development, and Decay

Children today eat softer, more processed foods. They chew less. That affects more than digestion—it changes their faces:

• Smaller jaws
• Narrower dental arches
• Crowded or rotated teeth
• Harder-to-clean spaces between teeth

These structural changes make interproximal cavities more likely—regardless of fluoride.²⁹ ³⁰

And yet, policy still centers around fluoridation.
We’re missing the forest for the trees.

Who Really Benefits?

• Fertilizer manufacturers — They profit by selling fluorosilicic acid, a byproduct that would otherwise require costly disposal. Turning industrial waste into a revenue stream provides substantial financial benefit.³²
• Chemical distributors — They buy fluoride compounds at low cost and resell them to municipal water systems at a markup as part of their treatment contracts.³³
• Public agencies — By promoting fluoridation as a low-cost preventive measure, agencies maintain the appearance of an inexpensive public health policy, even though dental costs have continued to rise.³⁴

Importantly, despite common belief, aluminum companies do not profit from municipal water fluoridation. ALCOA, the largest U.S. aluminum producer, sold its fluoride production facility over 70 years ago and no longer benefits from these sales.³⁵

Is There a Smarter Approach?

Many countries already know:

• Use fluoride varnish at dental visits
• Apply silver diamine fluoride to stop small cavities
• Offer supervised brushing programs in schools
• Provide parent education on bottle use and nutrition
• Improve access to care for underserved children

These strategies are ethical, efficient, and effective.

Final Thoughts: Awareness First

Fluoride is a fascinating story—part science, part history, and part public policy. What began as an industrial challenge grew into one of the largest public health experiments in history. Along the way, we’ve learned much about fluoride’s benefits, its limitations, and its risks.

This article isn’t meant to demand change or push an agenda. It’s meant to share what we know now—so that parents, communities, and health professionals can have more informed conversations.

A good comparison is antibiotics. When used properly, antibiotics can save lives and prevent suffering. But when they’re given too broadly, too often, or in the wrong way, they can cause harm—such as antibiotic resistance or unintended side effects. Fluoride, too, can be extremely beneficial when used topically and in controlled doses. But applying it universally through drinking water exposes people in ways that may not be necessary or even optimal today.

The truth is layered: fluoride can help, but it is not a one-size-fits-all solution. By understanding its history, its biology, and the many sources of exposure, we can better place it in context with modern nutrition, preventive care, and overall child health.

Ultimately, the goal is not alarm, but awareness. With knowledge, families can ask better questions, weigh the evidence, and make thoughtful decisions for their children and their communities.

📚 References

1. Chemical & Engineering News (2006)
2. Bryson, C. The Fluoride Deception (2004)
3. McKay, F.S., Journal of the American Dental Association (1930)
4. Churchill, H.V. Industrial & Engineering Chemistry (1931)
5. Cox, G.J. Mellon Institute (1939)
6. Sutton, P.R.N. Fluoridation: Errors and Omissions in Experimental Trials (1959)
7. Ziegelbecker, R. Fluoride Journal (1981)
8. Bryson, C. The Fluoride Deception (2004)
9. Grand Rapids Fluoridation Study (1945)
10. Masters, R., Coplan, M. Neurotoxicology (1999)
11. Featherstone, J.D.B. Dental Clinics of North America (2000)
12. CDC: National Center for Health Statistics (2022)
13. European Commission Public Health Report (2011)
14. AAPD Policy on Early Childhood Caries (2021)
15. EPA Exposure Assessment Report (2010)
16. National Research Council (NRC): Fluoride in Drinking Water (2006)
17. Luke, J. PhD thesis, University of Surrey (1997)
18. Brown, H.S. et al. American Journal of Public Health (1984)
19. European Commission Scientific Committee Opinion (2005)
20. Pureshowers.co.uk – “Why Your Shower Needs a Fluoride Filter” (2023)
21. EPA Safe Drinking Water Act Guidelines (2023)
22. FDA Fluoride Guidelines for Over-the-Counter Products (2021)
23. CDC Community Water Fluoridation Guidelines (2020)
24. NSF/ANSI Standard 60 Documentation
25. Coplan, M.J., Masters, R.D. International Journal of Environmental Studies (2001)
26. Maryland Oral Health Report (2021)
27. LA County Public Health Dental Survey (2019)
28. Michigan Medicaid Pediatric Dental Report (2020)
29. Corruccini, R.S. American Journal of Orthodontics (1984)
30. Urbanek, C. et al. Craniofacial Growth and Diet Softness, Journal of Human Evolution (2020)
31. CDC Health Expenditures Oral Health Module (2023)
32. U.S. EPA. Fluorosilicic Acid Supply Chain Profile. (2023)
33. Barron’s. Robert F. Kennedy Jr. on Fluoride in Water. (2023)
34. Fluoride Action Network. Bulletin on Fluoridation and Public Health Messaging. (2013)
35. Indiana Department of Health. Questions and Answers About Fluoridation. (2023)